Provider Demographics
NPI:1831228139
Name:WINEBARGER, ALLEN (PHD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:WINEBARGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1400
Mailing Address - Country:US
Mailing Address - Phone:616-844-4140
Mailing Address - Fax:616-604-1437
Practice Address - Street 1:509 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1400
Practice Address - Country:US
Practice Address - Phone:616-844-4140
Practice Address - Fax:616-604-1437
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010934103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G04527OtherBCBS PROVIDER #
MI6301010934OtherPSYCHOLOGIST LICENSE #